Breunig: Building the better emergency room

Published 8:25 pm, Friday, January 17, 2014

The emergency room is never a place you're happy to revisit. It's not like a restaurant that can lure you back with a menu of inventive new appetizers. It trumps even the DMV for serving the customer who wants to be elsewhere.

Five months ago I spent too many hours in the Stamford Hospital ER awaiting stitches to reunite pieces of my son's tongue after he fell and bit into it. I returned Tuesday, this time with no blood involved. My first column -- which pointed to more gaps in the system than there were in his tongue -- inspired a few calls offering a meeting. A mention in a recent column that the meeting never occurred drew a gracious apology and a fresh invite from Christopher J. Riendeau, senior vice president of fund development.

To recap, nine hours passed between my 20-month-old's tumble and his release from the emergency room in the wee hours of the morning. The Kid passed much of his down time taking several laps around the ER that exposed him to drunks spilling from lowered gurneys, dubious patients angling for narcotics, a fleet of U.S. Navy Sea Cadets, a squadron of cops surrounding a bleeding suspect and a neighbor whose curtain cautioned that she had an antibiotic-resistant infection. The Kid strolled through the landscape like Harpo Marx in a David Lynch version of "A Night at the Opera."

Our real gripe was that the head of the ER sent us there from the Tully Center so an on-duty oral surgeon could handle the stitches. The oral surgeon never made a cameo, and the resulting stitches left him (to plagiarize myself) pulling at a dangling thread like he was a human hand grenade, exploding every few minutes out of frustration.

My intention last week, though, was not to tie up dangling threads, but to get a peek at The ER of the Future. I appreciate the effort, just as I have endless respect for the hard work of the team in the ER.

If you need a reminder that Stamford is a real city, not a coloring book depiction of a New England town, just stop by the ER. I admit walking back into the room last week revived feelings of anxiety. It was like seeing a familiar play with new actors in the supporting roles. Hospital staff members remained admirably focused on their challenges while people of all ages shuffled around with all forms of immediate care concerns. Over the years, I've been in several crises where co-workers implored me to rush them to Greenwich Hospital instead of Stamford Hospital, recognizing the strain on the latter.

There is a reassurance in learning staff members share the frustration and agree that the hospital's expiration date for a makeover ran out years ago. When I asked if the staff feels squeezed in, Eilish C. Hourihan, director of clinical operations, offered a sly half-smile and nodded to the hub in the center of the madness. The answer is so obvious it deserved to be delivered in pantomime.

"This is like a fish bowl," Hourihan shrugged. "We're the mixing bowl for everyone."

The emergency room staff treats about 140 patients on an average day, and about 54,000 patients a year. That doesn't include people who opt for Stamford's Tully Center, which is designed for immediate health care. The original emergency room was built to treat less than half that many people.

One obvious difference in the new, 53,000-square foot Emergency and Trauma Center is that the curtains will be gone from the 21 rooms, replaced by 48 rooms (with doors) twice as large as their predecessors. For children, a scenario like ours would not happen, as there will be dedicated treatment areas for kids, adults and behavioral health patients. The "kids ER" will also be staffed by doctors and nurses credentialed to treat children.

That's enough to make me happy, but the staff knows they only get one crack at this, so they are collecting input from peers, patients and counterparts at modern facilities around the country.

Hourihan learned a hard lesson the last time she was part of an ER makeover. For all the planning, no one thought about storage space. "It was only opening day and I said, `Oh my God we have to put a stretcher in the hallway.' "

So everyone is meticulously comparing notes to ensure every detail is considered concerning comfort and efficiency. Predicting the best way to meet shifts in technology, of course, is challenging. Consider that the 1913 brick building that served as the original hospital (and is still used) was constructed decades before television. A century later, a hospital the team visited in Massachusetts received a donation of iPads for the children's ER, which can be effective in distracting the kids during distress.

Practical solutions for adult patients are being implemented as well. The ER will finally have low beds for those who need to "sleep it off" but should be kept close to the floor in case they fall out.

Everyone offers a different reason to look forward to the spring of 2016, the deadline for the new building. Ellen M. Komar, vice president of patient care services, offers the best reason the doors are overdue: "No infection control issues."

The old ER, of course, still has to try to satisfy customers -- around the clock -- for a couple more years.

Hospitals are graded by Press Ganey and Associates, which measures patient satisfaction at comparable hospitals. A decade ago those scores ranged from 40 percent to 60 percent, Komar recalls. According to Craig Andrews, the hospital's new public relations director, Press Ganey scores rose from the 68th percentile in 2010 to the 80th percentile in Fiscal Year 2013. Komar said a spike brought them close to 90 percent since the summer.

To better manage the outdated ER during construction, Komar said they are "trying not to leave patients in the waiting room if there is a bed available. And we're trying to get treat-and-release patients on the fast track, so patients do not feel they are constantly waiting." The average time in the ER these days, she says, is about three hours.

After my peek into the crystal ball, I join the staff in enthusiastically looking forward to a future with doors in the emergency room. The new Stamford Hospital will undoubtedly transform the city, and be a draw for neighboring towns. Even so, most of us pray we never have to see the inside of The ER of the Future.

Sorry, I couldn't bite my tongue on that one.

John Breunig is editorial page editor of The Advocate and Greenwich Time. He can be reached at john.breunig@scni.com; 203-964-2281; http://twitter.com/johnbreunig.